Fast-Track Cardiac Anesthesia — MCQs
The following combination of agents is preferred for short day care surgeries –
In which clinical scenario would you find a patient requiring the vital signs assessment technique shown in the image?
Which of the following statements given below is incorrect regarding CPR?
Which drug is commonly used for emergency intubation?
In the TRIAGE system for disaster management, which of the following color codes denotes "high-priority treatment and/or transfer"?
Patient was planned for surgery under GA, in the induction phase rocuronium was given 85mg but the anesthetist did not succeed in intubating. Which could be the best reversal agent used?
Which of the following is the FIRST-LINE antiemetic drug most commonly used for post-operative nausea and vomiting (PONV) prophylaxis?
An induction agent of choice for poor-risk patients with cardiorespiratory disease as well as in situations where preservation of a normal blood pressure is crucial:-
Effective adjuvant in attenuating hypertension and tachycardia associated with laryngoscopy and intubation?
Drug that does not cause cardiac depression:
Fast-Track Cardiac Anesthesia Indian Medical PG Practice Questions and MCQs
Question 1: The following combination of agents is preferred for short day care surgeries –
- A. Propofol, fentanyl, isoflurane (Correct Answer)
- B. Thiopentone sodium, morphine, halothane
- C. Ketamine, pethidine, halothane
- D. Propofol, morphine, halothane
Explanation: ***Propofol, fentanyl, isoflurane*** - This combination is preferred due to the **rapid onset and offset** characteristics of its components, which is crucial for **short day care surgeries**. - **Propofol** provides rapid induction and smooth maintenance, **fentanyl** offers effective analgesia with a short duration of action, and **isoflurane** allows for precise control of anesthesia depth with quick emergence. *Thiopentone sodium, morphine, halothane* - **Thiopentone social** has a slower recovery profile than propofol, which is less ideal for **day care surgery** settings. - **Morphine** has a longer duration of action and a higher incidence of postoperative nausea and vomiting compared to fentanyl. *Ketamine, pethidine, halothane* - **Ketamine** can cause significant psychomimetic side effects and a longer recovery time, making it less suitable for **short day care surgeries**. - **Pethidine** also has a longer duration of action and can lead to more problematic sedative effects post-operatively compared to fentanyl. *Propofol, morphine, halothane* - While **propofol** is an excellent choice for induction and maintenance, **morphine's** longer duration of action and potential for more significant postoperative side effects like nausea and vomiting make it less favorable for quick recovery in **day care surgery**. - **Halothane** is rarely used currently due to its association with **hepatotoxicity** and **cardiac arrhythmias**.
Question 2: In which clinical scenario would you find a patient requiring the vital signs assessment technique shown in the image?
- A. Pulse absent, breath present
- B. Pulse and breath both not present
- C. Pulse and breath present
- D. Pulse present, breath absent (Correct Answer)
Explanation: ***Pulse present, breath absent*** - The image depicts a **mouth-to-mouth resuscitation** technique, specifically rescue breaths being administered by one person to another. - This technique is applied when a person has a **detectable pulse** but is **not breathing** or is only gasping, indicating respiratory arrest while the heart is still circulating blood. *Pulse absent, breath present* - This scenario would represent **cardiac arrest** where the heart has stopped, but the person is still attempting to breathe. This is a rare, transient state. - In such a case, the primary intervention would be **chest compressions**, not just rescue breathing, as circulation is the immediate priority. *Pulse and breath both not present* - This describes **cardiopulmonary arrest (CPA)**, where both the heart and lungs have ceased functioning. - The appropriate intervention is **cardiopulmonary resuscitation (CPR)**, which involves a combination of **chest compressions and rescue breaths (30:2 ratio)**, not just rescue breaths alone. *Pulse and breath present* - If both vital signs are present, the person is **conscious and breathing adequately**, or unconscious but breathing normally. - No advanced respiratory intervention like mouth-to-mouth resuscitation is needed; the priority would be maintaining their airway and monitoring their condition.
Question 3: Which of the following statements given below is incorrect regarding CPR?
- A. Chest compression rate 100-120/min
- B. Depth of chest compression up to 5-6 cm
- C. Ventilation 22-25/ min (Correct Answer)
- D. Allow adequate chest recoil
Explanation: ***Ventilation 22-25/ min*** - A ventilation rate of 22-25 breaths/min is **too high** for CPR, which typically recommends 10-12 breaths/min, corresponding to 2 breaths after every 30 compressions. - Excessive ventilation can lead to **hyperventilation**, increasing intrathoracic pressure and reducing venous return, thus decreasing cardiac output. *Chest compression rate 100-120/min* - The recommended chest compression rate for adults in CPR is **100-120 compressions per minute**, ensuring adequate blood flow to vital organs. - Maintaining this rate is crucial for maximizing the effectiveness of chest compressions by providing sufficient circulation. *Depth of chest compression up to 5-6 cm* - The recommended depth for adult chest compressions is at least 5 cm (2 inches), but no more than **6 cm (2.4 inches)** to prevent injury. - This depth ensures that enough pressure is exerted to circulate blood effectively without causing excessive trauma. *Allow adequate chest recoil* - Complete chest recoil is essential to allow the heart to **fully refill with blood** between compressions. - Leaning on the chest between compressions prevents adequate recoil, which can reduce pulmonary and coronary perfusion and **decrease the effectiveness of CPR**.
Question 4: Which drug is commonly used for emergency intubation?
- A. None of the options
- B. Etomidate (Correct Answer)
- C. Propofol
- D. Ketamine
Explanation: ***Etomidate*** - Etomidate is a **short-acting nonbenzodiazepine hypnotic** often preferred for rapid sequence intubation (RSI) due to its minimal impact on **hemodynamic stability**. - It induces **rapid unconsciousness** with a quick onset and offset, making it suitable for emergency airway management in patients who are hemodynamically compromised. *Propofol* - Propofol is a **potent intravenous anesthetic** that can cause significant **hypotension** due to vasodilation and myocardial depression. - While it provides rapid onset of sedation and amnesia, its cardiovascular side effects make it less ideal for patients with **unstable hemodynamics** during emergency intubation. *Ketamine* - Ketamine is a **dissociative anesthetic** that causes a cataleptic state, amnesia, and analgesia, often leading to **bronchodilation** and cardiovascular stimulation. - While useful in patients with **reactive airway disease** or hypotension, it can increase intracranial pressure and may induce sympathetic stimulation, which might not be ideal for all emergency intubation scenarios. *None of the options* - This option is incorrect because **Etomidate is a commonly used drug** for emergency intubation, particularly where hemodynamic stability is a concern. - Other agents are also used but Etomidate is a clear clinical choice in many situations.
Question 5: In the TRIAGE system for disaster management, which of the following color codes denotes "high-priority treatment and/or transfer"?
- A. Red (Correct Answer)
- B. Black
- C. Yellow
- D. Green
Explanation: ***Red*** - The **red tag** in the TRIAGE system signifies critical injuries requiring **immediate intervention** and transport to save life or limb. - Patients tagged red have a high priority for treatment with a good chance of survival if attended to promptly. - This represents the **highest priority** category for "high-priority treatment and/or transfer." *Green* - The **green tag** indicates patients with **minor injuries** who can walk and care for themselves. - Also known as the "**walking wounded**," these patients require minimal or delayed medical attention. - They have the **lowest priority** in disaster triage and can wait hours for treatment. *Black* - A **black tag** indicates the patient is **deceased** or has injuries so severe that survival is unlikely given the available resources. - These patients are assigned a low priority for treatment to allocate resources to those with a better prognosis. - Also called "**expectant**" in some systems. *Yellow* - The **yellow tag** designates patients with **serious, but non-life-threatening injuries** who can wait for treatment for a few hours. - These patients are stable enough that they do not require immediate intervention but will need medical attention. - Examples include fractures, moderate burns, or stable abdominal injuries.
Question 6: Patient was planned for surgery under GA, in the induction phase rocuronium was given 85mg but the anesthetist did not succeed in intubating. Which could be the best reversal agent used?
- A. Neostigmine (non-specific acetylcholinesterase inhibitor)
- B. Glycopyrrolate (anticholinergic agent)
- C. Edrophonium (non-specific acetylcholinesterase inhibitor)
- D. Sugammadex (specific reversal agent for rocuronium) (Correct Answer)
Explanation: ***Sugammadex (specific reversal agent for rocuronium)*** - **Sugammadex** is a modified gamma-cyclodextrin that forms a tight, water-soluble complex with **rocuronium**, effectively encapsulating and inactivating it. - It is highly effective for rapid reversal of **rocuronium**-induced neuromuscular blockade, especially in situations where immediate reversal is critical, such as a "cannot intubate, cannot ventilate" scenario. *Neostigmine (non-specific acetylcholinesterase inhibitor)* - **Neostigmine** acts by inhibiting **acetylcholinesterase**, increasing the amount of acetylcholine at the neuromuscular junction to overcome the competitive block. - Its reversal effect is slower and less reliable than sugammadex, especially after a large dose of rocuronium or deep blockade. *Glycopyrrolate (anticholinergic agent)* - **Glycopyrrolate** is an **anticholinergic** agent used to counteract the muscarinic side effects (e.g., bradycardia, salivation) of **acetylcholinesterase inhibitors** like neostigmine, but it has no direct reversal effect on neuromuscular blockade. - It is typically co-administered with neostigmine, not used as a standalone reversal agent for **rocuronium**. *Edrophonium (non-specific acetylcholinesterase inhibitor)* - **Edrophonium** is a short-acting **acetylcholinesterase inhibitor**, similar to neostigmine but with a more rapid onset and shorter duration of action. - It is less potent and effective than neostigmine for reversing moderate to deep neuromuscular blockade and would not be the best choice after a significant dose of **rocuronium**.
Question 7: Which of the following is the FIRST-LINE antiemetic drug most commonly used for post-operative nausea and vomiting (PONV) prophylaxis?
- A. Lorazepam
- B. Metoclopramide
- C. Promethazine
- D. Ondansetron (Correct Answer)
Explanation: ***Ondansetron*** - **Ondansetron** is a **5-HT3 receptor antagonist** and is considered a first-line agent due to its high efficacy and favorable side effect profile in preventing PONV. - It works by blocking serotonin receptors in the **chemoreceptor trigger zone** and the **gastrointestinal tract**, reducing the sensation of nausea and vomiting. *Lorazepam* - **Lorazepam** is a **benzodiazepine** primarily used for its **anxiolytic** and **sedative effects**, and sometimes as an adjunct for refractory nausea, but not as a first-line antiemetic for PONV prophylaxis. - While it can help indirectly by reducing anxiety, it does not directly target the key pathways involved in PONV as effectively as 5-HT3 antagonists. *Phenytoin* - **Phenytoin** is an **anticonvulsant** medication used to prevent seizures and has no role in the direct treatment or prophylaxis of PONV. - It primarily acts on voltage-gated sodium channels in neurons and does not possess antiemetic properties. *Metoclopramide* - **Metoclopramide** is a **dopamine D2 receptor antagonist** and a **prokinetic agent** that can be used for PONV, particularly when gastric stasis is a concern. - However, it is generally considered a second-line agent due to the risk of **extrapyramidal side effects**, especially with higher doses or prolonged use. *Promethazine* - **Promethazine** is a **first-generation antihistamine** with **antidopaminergic** and **anticholinergic properties** that can be effective for nausea and vomiting. - It is often used as a rescue antiemetic or in combination therapy, but its sedative effects and potential for extrapyramidal symptoms make it less preferable as a first-line prophylactic agent compared to ondansetron.
Question 8: An induction agent of choice for poor-risk patients with cardiorespiratory disease as well as in situations where preservation of a normal blood pressure is crucial:-
- A. Ketamine
- B. Etomidate (Correct Answer)
- C. Propofol
- D. Thiopentone
Explanation: ***Etomidate*** - Etomidate is preferred in patients with **cardiac disease** or **hemodynamic instability** due to its minimal effects on cardiovascular function. - It maintains **cardiovascular stability**, including myocardial contractility and blood pressure, making it ideal for procedures where maintaining a normal blood pressure is crucial. *Ketamine* - Ketamine often causes a **sympathetic stimulating effect**, leading to increases in heart rate and blood pressure, which may be detrimental in such patients. - It is associated with **tachycardia** and **hypertension**, undesirable in a poor-risk patient with cardiorespiratory disease. *Propofol* - Propofol is a potent **vasodilator** and myocardial depressant, which can lead to significant **hypotension**, especially in volume-depleted or critically ill patients. - Its use can result in a dose-dependent decrease in **arterial blood pressure** and **cardiac output**. *Thiopentone* - Thiopentone can cause **myocardial depression** and significant **hypotension**, especially in patients with compromised cardiovascular function. - It leads to a notable decrease in **vascular tone** and venous return, thus lowering blood pressure.
Question 9: Effective adjuvant in attenuating hypertension and tachycardia associated with laryngoscopy and intubation?
- A. Suxamethonium
- B. Fentanyl (Correct Answer)
- C. Ketamine
- D. Atracurium
Explanation: ***Fentanyl*** - **Fentanyl**, a potent **opioid**, effectively blunts the **sympathetic response** associated with **laryngoscopy** and **intubation**, thereby reducing **hypertension** and **tachycardia**. - Its rapid onset and short duration of action make it a suitable **adjuvant** for this purpose. *Suxamethonium* - **Suxamethonium** is a **depolarizing neuromuscular blocker** used to facilitate intubation, not to attenuate the hemodynamic response. - It does not directly impact **blood pressure** or **heart rate** in a way that would mitigate the stress response. *Ketamine* - **Ketamine** can cause **sympathomimetic effects**, including **increased heart rate** and **blood pressure**, which would worsen rather than attenuate the hemodynamic response to intubation. - It is often used for its **dissociative anesthetic** properties, not for blunting the stress response. *Atracurium* - **Atracurium** is a **nondepolarizing neuromuscular blocker** used for muscle relaxation during intubation and surgery. - It does not directly affect **blood pressure** or **heart rate** in a manner that would attenuate the hypertensive and tachycardic response to laryngoscopy.
Question 10: Drug that does not cause cardiac depression:
- A. Thiopentone
- B. Ketamine
- C. Propofol
- D. Etomidate (Correct Answer)
Explanation: ***Etomidate*** - Etomidate is known for its **cardiovascular stability**, making it a preferred induction agent in patients with **compromised cardiac function**. - It maintains **myocardial contractility** and does not typically cause a significant drop in blood pressure. *Thiopentone* - Thiopentone causes **dose-dependent myocardial depression** and peripheral vasodilation. - This can lead to a significant **decrease in blood pressure** and cardiac output, especially in hypovolemic patients. *Propofol* - Propofol is a potent **vasodilator** and can cause significant **myocardial depression**, leading to hypotension. - Its cardiovascular effects are often more pronounced than those of other induction agents, necessitating careful titration. *Ketamine* - Ketamine causes indirect cardiovascular stimulation (due to **sympathetic nervous system activation**), but direct myocardial depression. - While it often increases heart rate and blood pressure, this is a compensatory mechanism and its direct effect on the myocardium is depressant.
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